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Objectives: To describe the prevalence of rheumatoid nodules [RN] in patients with rheumatoid arthritis [RA] and to compare their features with those of patients without RN
Subjects and Methods: Adult RA patients [n = 952] in the Kuwait Registry for Rheumatic Diseases from February 2013 to December 2015 were evaluated for RN. Demographic and serological features and disease activity and severity were obtained from the registry
Results: Of the 952 RA patients, 22 [2.3%] had RN and 930 [97.7%] did not. Age, sex, disease duration, smoking, and family history of an autoimmune rheumatic disease were similar. Obesity was more prevalent in the RN group, i.e. 11 [50%] vs. 326 [35.1%], p = 0.016. There was no difference in rheumatoid factor [RF] or anti-cyclic citrullinated peptide antibody positivity. Patients with RN had more sicca symptoms, i.e. 8 [36.4%] vs. 152 [16.3%], p = 0.025, a higher mean score on the visual analogue scale pain [3 +/- 2.9 vs. 2 +/- 2.7, p < 0.001], more tender joints [6.4 +/- 8.8 vs. 4.2 +/- 7.2, p = 0.001], a higher patient global assessment of disease activity [3.3 +/- 2.7 vs. 2.3 +/- 2.7, p < 0.001], and more deformities, i.e. 3 [13.6%] vs. 74 [8%], p = 0.034. The mean health assessment questionnaire score in RN patients was 1.1 versus 0.9 in patients without RN [p = 0.08]. Patients with RN had a low disease activity [means: disease activity score [DAS-28], 3.02; clinical disease activity index, 7.7; and simple disease activity index, 10.4], similar to the other group. While the rates of methotrexate treatment were comparable, biologic therapy was administered more in patients with RN [i.e. 15 [68.2%] vs. 478 [51.4%], p < 0.001]
Conclusion: In Kuwait, the prevalence of RN is low among RA patients. Patients with and without RN are similar in terms of demographics and serologic features, except for more obesity. However, patients with RN have more sicca symptoms, joint deformities, and painful and tender joints. Disease activity scores are low with more frequent biologic therapy
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To investigate the effect of 25-hydroxyvitamin D [25[OH]D] in Kuwaiti patients with primary knee osteoarthritis [OA] and to assess its relation with radiological grading and functional status. In this cross-sectional study, 25[OH]D was measured using radioimmunoassay in 99 patients [90 women and 9 men; mean age 56.5 +/- 9.1 years [range: 36-80]] with clinical and radiological findings of primary knee OA. X-ray grading using the Kellgren-Lawrence grading scale and the Osteoarthritis Research Society International [OARSI] Atlas grading scale and functional assessments using Lequesne's indices were evaluated in relation to the 25[OH]D level. Other variables studied were age at onset of symptoms, body mass index and duration of disease. The age of the patients at the onset and the duration of disease were 51.58 +/- 7.14 and 3.88 +/- 2.51 years, respectively. Mean scoring for functional assessment was 10.31 +/- 4.35 and mean Kellgren-Lawrence radiological grading was 2.43 +/- 0.85. Radiological finding according to the OARSI Atlas revealed joint space narrowing of grades 2-3 in 87 [87.9%] patients and the presence of osteophytes in 55 [55.6%] patients. The mean value of 25[OH]D level was 11.4 +/- 6.07 ng/ml. Of the 99 patients, 92 [92.9%] were vitamin D deficient. Comparison of 25[OH]D levels to radiological findings and different functional classes showed no significant association. Most of our patients had vitamin D deficiency, but the level of 25[OH]D was not related to the severity of the knee X-ray grading or to the functional assessment in our patients with primary knee OA
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Radiological and histological evaluations are affected by subjective interpretation. This study determined the level of inter- and intraobserver variation among radiologists for detection of abnormal parenchymal lung changes on high resolution computed tomography [HRCT]. HRCT images of 65 patients known to have systemic lupus erythematosus [with clinical pulmonary involvement] were retrospectively reviewed by four nonthoracic radiologists [two with expertise in magnetic resonance [MR] and two general radiologists]. Each radiologist read the scans twice, with an interval between readings of at least 6 months. The interobserver variation among the first and second readings of the four radiologists and the intraobserver variation of each radiologist's two readings were assessed by the kappa statistic. There was good agreement between the first and second readings of each radiologist. There was moderate agreement between the two readings of one MR radiologist [kappa=0.482]; the other three radiologists had kappa values that were good to excellent [0.716, 0.691, and 0.829]. There was a clinically acceptable level of interobserver variability between all radiologists. The agreement was fair to moderate between the MR radiologist and the other observers [kappa range: 0.362-0.519] and moderate to good between the other three radiologists [0.508-0.730]. The interpretation of imaging findings of abnormal parenchymal lung changes on HRCT is reproducible and the agreement between general radiologists is clinically acceptable. There is reduced agreement when the radiologist is not involved on a regular basis with thoracic imaging. Difficult or indeterminate cases may benefit from review by a chest radiologist